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Patient perceptions of office visit copayments alter care-seeking behaviors

As health care costs have risen, patient cost-sharing through copayments for office visits and other mechanisms have increasingly been used to reduce unnecessary treatments and costs. Yet a new study found that one out of two patients did not know the amount of their physician visit copayment and 27 percent of patients said they changed their care-seeking behavior because of their perception of the amount of the copayment. Overall, 15 percent reported delaying an office visit and 14 percent avoided care altogether.

Researchers interviewed 479 adult members of a prepaid integrated delivery system by telephone about their knowledge of office visit copayments and their responses to them. The copayment amounts ranged from $5 to $40. Sixty-eight percent of patients knew their actual copayment amount within $5 and 89 percent were correct within $10 of the actual amount. Only 4 percent of patients reported talking with physicians about these costs. Most respondents believed that physicians cannot help with costs (79 percent) and that it is inappropriate to discuss costs with physicians (51 percent).

The researchers suggest that the respondents' limited knowledge of copayment amounts raises questions about their ability to navigate newer, more complex benefits designs such as deductible plans. These plans may include exemptions for preventive services, but require the enrollee to pay the full cost for nonpreventive visits until the deductible is reached. Earlier studies had shown that higher actual office visit fees were associated with fewer visits.

This study differs from these earlier studies by finding that the perceived office visit copayment is more predictive of behavioral changes in response to costs than the actual copayment. More research will be needed to show whether patients who change their care-seeking behavior in response to office visit copayments experience adverse health outcomes. This study was supported by the Agency for Healthcare Research and Quality (HS11434).

See "Office visit copayments. Patient knowledge, response, and communication with providers," by Nancy J. Benedetti, B.S.B., Vicki Fung, Ph.D., Mary Reed, Dr.PH., and others, in the April 2008 Medical Care 46(4), pp. 403-409.

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